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Lumbar Stenosis
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
While this is a controversial area, there are some recommendations from the World Federation of Neurosurgical Societies: In patients with lumbar spine stenosis and no sign or symptoms of instability and predominant leg pain, decompression alone is recommended.In patients with stenosis and stable spondylolisthesis, fusion is not mandatory, and decompression alone is suggested.Unstable spondylolisthesis with symptoms may require fusion.Fusion may be advisable in patients who undergo bilateral facetectomy of more than 50% and bilateral discectomy.There is no consensus if the main complaint is mechanical axial low back pain, which is more than leg pain; the patient may benefit from a fusion surgery.
How to perform revision lumbar decompression
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Jacob Hoffman, Ryan Murphy, Mark L. Prasarn, Shah-Nawaz M. Dodwad
If the decompression is carried out too laterally, the surgeon can cause an iatrogenic pars defect or complete facetectomy with resultant instability. Unrecognized defects may lead to progressive deformity or increased lumbar pain postoperatively, with possible recurrent stenosis. Patients may require a stabilization procedure depending on pathology.
The Comprehensive Anatomical Spinal Osteotomy Classification *
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
A Grade 1 osteotomy is a partial facetectomy involving the resection of the inferior facet and joint capsule at a given spinal level. This provides limited correction and requires a mobile anterior column to be effective. This osteotomy is performed via a posterior approach.
Mid thoracic intra-spinal facet cyst with lumbar canal stenosis: a rare ‘double crush’
Published in International Journal of Neuroscience, 2023
Abhinandan Reddy Mallepally, Nandan Marathe, Jeevan Kumar Sharma, Bibhudendu Mohaptra, Kalidutta Das
Intralesional or epidural steroid injections are reported to provide temporary relief [16, 19,20] owing to anti-inflammatory action of steroids. Although, CT-guided aspiration frequently utilized in the lumbar region has not been reported in dorsal spine cysts owing to narrow canal and concern regarding myelopathy. Symptomatic radiculopathy and myelopathy call for surgical decompression. [21]. But the optimal surgical strategy remains controversial. Though laminectomy and medial facetectomy is recommended, iatrogenic instability is a matter of concern. Hence fusion is suggested when wide decompression is performed. Operating surgeon must plan instrumented fusion in addition to the decompression based on assessment of instability, degree of degeneration of the segment, and associated axial pain.
Trans-sacral epiduroscopic laser decompression versus the microscopic open interlaminar approach for L5-S1 disc herniation
Published in The Journal of Spinal Cord Medicine, 2020
Seung-Kook Kim, Su-Chan Lee, Seung-Woo Park
Axillary herniated discs can be removed easily using the trans-sacral endoscopic approach. The S1 nerve root exits at the L5-S1 level. The S1 root is already separated from the thecal sac.5 The angle between the S1 root and thecal sac allows surgeons to access the axillary potion of the S1 nerve root.22 Axillary disc herniation increases the root thecal sac angle and creates more space for the endoscope without causing root damage. SELD can directly access the axillary herniated disc and decompress the disc fragment without general anesthesia, and muscle and bone injury with minimal manipulation of the neural structure. However, sometimes during SELD, which is associated with the risk of incomplete decompression or a remnant disc, invasion into the epidural space is required after incising the posterior longitudinal ligament to completely remove the dorsally migrated disc fragment. Shoulder-type disc herniation can be treated using either technique. However, with OLD, nerve traction is required to approach the shoulder area of the nerve root. Nerve traction of the S1 nerve root can cause damage because the S1 root emerges from the thecal sac at the L5-S1 disc space. Sufficient medial facetectomy is required to create space. In this case series, 30% of patients required medial facetectomy. Although updated instruments such micro-retractors and drills have been developed, bone manipulation can potentially cause instability.23
Endoscopic transforaminal lumbar interbody fusion: a comprehensive review
Published in Expert Review of Medical Devices, 2019
Yong Ahn, Myung Soo Youn, Dong Hwa Heo
Some characteristics are common across the three reported techniques. First, all strategies generally involve a posterolateral transforaminal approach with either total or partial facetectomy. Second, visualization is obtained through an endoscopic system rather than through an operating microscope. Third, the decompression procedure is similar to that used in MIS-TLIF, regardless of the type of endoscope used. However, endoscopic TLIF and MIS-TLIF differ in terms of some key features. First, endoscopic TLIF requires a smaller skin incision with less muscle dilation, though there is no evidence that this actually results in less pronounced muscle trauma. Second, endoscopic TLIF allows more flexibility in terms of the method of anesthesia. Unlike MIS-TLIF, endoscopic TLIF can be performed under local anesthesia or conscious sedation, which is a unique benefit of endoscopic TLIF. Third, despite these advantages, the indication of endoscopic TLIF may be limited to degenerative stenosis with low-grade spondylolisthesis, whereas MIS-TLIF is more appropriate for deformity correction or reduction of vertebral slippage in high-grade spondylolisthesis. Finally, the optimal instrumentation technique to accomplish solid fusion or stabilization of the vertebral segment in endoscopic TLIF has yet to be established.